Provider Demographics
NPI:1447706601
Name:DONALD, BREANNA (DMD)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:DONALD
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 TERRETT AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1148
Mailing Address - Country:US
Mailing Address - Phone:571-215-7470
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 302
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-1705
Practice Address - Country:US
Practice Address - Phone:703-726-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857357122300000X, 1223P0221X
PADS041032122300000X, 1223P0221X
DCDEN10021781223P0221X
VA04014172601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist